Expiratory Lung Crackles in Patients with Fibrosing Alveolitis

Lung crackles are characterized by their quality ‘ (coarse or fine) and where they occur in the respiratory cycle. Coarse early inspiratory crackles are typical of chronic airflow limitation, while showers of fine late inspiratory crackles are a relatively constant feature of fibrosing alveolitis. Coarse expiratory crack­les are described in patients with chronic airflow limitation, but neither coarse nor fine expiratory crackles have been documented in fibrosing alveolitis. It was our clinical impression that expiratory crackles do occur in fibrosing alveolitis and we therefore undertook a clinical and phonopneumographic assess­ment of lung crackles in patients with this disorder.

Patients and Methods

Batients

Successive patients attending the chest clinic with a clinical diagnosis of fibrosing alveolitis were studied. All patients had a history of progressively increasing breathlessness associated with fine inspiratory lung crackles, a restrictive pulmonary function defect, impaired gas transfer, and diffuse pulmonary shadowing on chest x-ray film. In two, the diagnosis was confirmed by open lung biopsy. Patients with heart failure, sputum production, wheezing, or significant exposure to asbestos were excluded.

After consent, each patient gave a full history. The presence or absence of expiratory crackles was noted on physical examination. Lung volumes, spirometry and the gas transfer factor were meas­ured. order levitra professional

Thirteen patients with a mean age of 67 years (range 52 to 83 years) met criteria for the study. Ten had cryptogenic disease and three had fibrosing alveolitis secondary to autoimmune disease (two rheumatoid arthritis, one systemic sclerosis). There were seven men; eight were exsmokers, and six had finger clubbing.

The mean FEV, (± SD) of the 13 patients was 1.68 (± 0.37)L, 66 percent of predicted values, while the mean FVC was 2.3 (± 0.45)L, 61 percent of predicted. As a group, the patients did not have airflow obstruction; the mean FEV/FVC value was 73 percent (± 10). Five patients had an FEV/FVC % below 70, two with values of 69, the other three being 63, 61 and 53 percent respectively. Gas transfer was impaired in all cases with a mean of 48 (± 16) percent of predicted.